RESUMO
Arsenic exposure is a global health concern. This toxic metalloid is ubiquitous in the environment and contaminates food and drinking water. Once ingested, it undergoes a complex metabolic process within the body, which contributes to its accumulation and reactivity. Arsenic toxicity stems from the induction of oxidative stress, inhibition of thiol-containing proteins, and mimicry of inorganic phosphates. Arsenic poisoning is associated with the development of reproductive disorders. In males, arsenic causes a reduction in testicular weight and alterations in steroidogenesis and spermatogenesis. Moreover, it reduces the number and quality of spermatozoa harvested from the cauda epididymis. The mitochondria are targets of arsenic toxicity because of the production of free radicals and their high content of cysteine-rich proteins and fatty acids. Mitochondrial dysfunction may contribute to reproductive disorders because this organelle is crucial for controlling testicular and epididymal events related to sperm production and maturation. All of these alterations mediated by arsenic exposure contribute to the failure of male reproductive competence by reducing gamete viability. This review describes the potential mechanisms of arsenic toxicity, its detrimental effects on male reproductive organs, and consequences on sperm fertility.(AU)
Assuntos
Humanos , Animais , Masculino , Intoxicação por Arsênico/diagnóstico , Fármacos para a Fertilidade Masculina/análise , Mitocôndrias/química , Estresse Oxidativo/fisiologia , Epididimo/químicaRESUMO
Arsenic and its compounds are well-established, potent, environmentally widespread and persistent toxicants with metabolic, genotoxic, mutagenic, teratogenic, epigenetic and carcinogenic effects. Arsenic occurs naturally in the Earth's crust, but anthropogenic arsenic emissions have surmounted the emissions from important natural sources such as volcanism. Inorganic arsenicals exhibit acute and chronic toxicities in virtually all cell types and tissues, and hence arsenic intoxication affects multiple systems. Whereas acute arsenic intoxication is rare and relatively easy to diagnose, chronic arsenic intoxication (CAsI) is common but goes often misdiagnosed. Based on a review of the literature as well as our own clinical experience, we propose a chronic arsenic intoxication diagnostic score (CAsIDS). A distinctive feature of CAsIDS is the use of bone arsenic load as an essential criterion for the individual risk assessment of chronic arsenic intoxication, combined with a systemic clinical assessment. We present clinical examples where CAsIDS is applied for the diagnosis of CAsI, review the main topics of the toxicity of arsenic in different cell and organ systems and discuss the therapy and prevention of disease caused or aggravated by chronic arsenic intoxication. CAsIDS can help physicians establish the diagnosis of CAsI and associated conditions.
Assuntos
Intoxicação por Arsênico/diagnóstico , Arsênio/toxicidade , Exposição Ambiental/efeitos adversos , Poluentes Ambientais/toxicidade , Doença Aguda , Fatores Etários , Arsênio/farmacocinética , Intoxicação por Arsênico/epidemiologia , Intoxicação por Arsênico/urina , Doença Crônica , Exposição Ambiental/análise , Poluentes Ambientais/farmacocinética , Humanos , Índice de Gravidade de Doença , Distribuição TecidualRESUMO
Monosodium methanearsonate (MSMA) is an organic form of arsenic present in the formulations of some herbicides. Accidental ingestion of pasture contaminated with arsenic may lead to toxicosis in cattle. Almost 200 head of cattle maintained in an area sprayed with MSMA presented with intense diarrhea and dehydration after grazing. Subsequently, 16 of these animals died. Toxic levels of arsenic (>1.5µg/g) were detected in the kidney, liver, urine, and skeletal muscle of 6 animals. At gross inspection were observed multifocal to coalescent ulcers in the mucosa from on the forestomachs associated with hemorrhagic areas and marked wall edema. Microscopic examination mainly showed fibrinoid necrosis of vessels with multifocal thrombosis associated with ischemic infarction that were characterized by large transmural necrotic areas in the forestomachs. The clinical and pathological changes interestingly showed that this form of arsenic although considered less toxic, has caused severe vascular injury in forestomachs of cattle.(AU)
Metano-arseniato ácido monossódico (MSMA) é uma forma orgânica de arsênio, presente nas formulações de alguns herbicidas. A ingestão acidental de pasto contaminado por arsênio pode levar a toxicose em bovinos. Aproximadamente 200 bovinos que estavam em uma pastagem pulverizada com MSMA manifestaram intensa diarreia e desidratação após o pastejo. Subsequentemente, 16 animais morreram. Níveis tóxicos de arsênio (>1.5µg/g) foram detectados no rim, fígado, urina e músculo esquelético de 6 animais. A inspeção macroscópica revelou úlceras multifocais a coalescentes na mucosa de pré-estômagos, adjacentes a focos de hemorragia e intenso edema de parede. A avaliação microscópica revelou, predominantemente, necrose fibrinoide de vasos com trombose multifocal associada a infarto, caracterizado por grandes áreas de necrose transmural em pré-estômagos. As alterações clínicas e patológicas, interessantemente, demonstraram que esta forma de arsênio, apesar de ser considerada menos tóxica, causou severa injúria vascular em pré-estômagos de bovinos.(AU)
Assuntos
Animais , Bovinos , Arsênio/toxicidade , Trombose Venosa/veterinária , Intoxicação por Arsênico/diagnóstico , Necrose/veterináriaRESUMO
Monosodium methanearsonate (MSMA) is an organic form of arsenic present in the formulations of some herbicides. Accidental ingestion of pasture contaminated with arsenic may lead to toxicosis in cattle. Almost 200 head of cattle maintained in an area sprayed with MSMA presented with intense diarrhea and dehydration after grazing. Subsequently, 16 of these animals died. Toxic levels of arsenic (>1.5µg/g) were detected in the kidney, liver, urine, and skeletal muscle of 6 animals. At gross inspection were observed multifocal to coalescent ulcers in the mucosa from on the forestomachs associated with hemorrhagic areas and marked wall edema. Microscopic examination mainly showed fibrinoid necrosis of vessels with multifocal thrombosis associated with ischemic infarction that were characterized by large transmural necrotic areas in the forestomachs. The clinical and pathological changes interestingly showed that this form of arsenic although considered less toxic, has caused severe vascular injury in forestomachs of cattle.(AU)
Metano-arseniato ácido monossódico (MSMA) é uma forma orgânica de arsênio, presente nas formulações de alguns herbicidas. A ingestão acidental de pasto contaminado por arsênio pode levar a toxicose em bovinos. Aproximadamente 200 bovinos que estavam em uma pastagem pulverizada com MSMA manifestaram intensa diarreia e desidratação após o pastejo. Subsequentemente, 16 animais morreram. Níveis tóxicos de arsênio (>1.5µg/g) foram detectados no rim, fígado, urina e músculo esquelético de 6 animais. A inspeção macroscópica revelou úlceras multifocais a coalescentes na mucosa de pré-estômagos, adjacentes a focos de hemorragia e intenso edema de parede. A avaliação microscópica revelou, predominantemente, necrose fibrinoide de vasos com trombose multifocal associada a infarto, caracterizado por grandes áreas de necrose transmural em pré-estômagos. As alterações clínicas e patológicas, interessantemente, demonstraram que esta forma de arsênio, apesar de ser considerada menos tóxica, causou severa injúria vascular em pré-estômagos de bovinos.(AU)
Assuntos
Animais , Bovinos , Arsênio/toxicidade , Trombose Venosa/veterinária , Intoxicação por Arsênico/diagnóstico , Necrose/veterináriaRESUMO
Several novel mechanistic findings regarding to arsenic's pathogenesis has been reported and some of them suggest that the etiology of some arsenic induced diseases are due in part to heritable changes to the genome via epigenetic processes such as DNA methylation, histone maintenance, and mRNA expression. Recently, we reported that arsenic exposure during in utero and early life was associated with impairment in the lung function and abnormal receptor for advanced glycation endproducts (RAGE), matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) sputum levels. Based on our results and the reported arsenic impacts on DNA methylation, we designed this study in our cohort of children exposed in utero and early childhood to arsenic with the aim to associate DNA methylation of MMP9, TIMP1 and RAGE genes with its protein sputum levels and with urinary and toenail arsenic levels. The results disclosed hypermethylation in MMP9 promotor region in the most exposed children; and an increase in the RAGE sputum levels among children with the mid methylation level; there were also positive associations between MMP9 DNA methylation with arsenic toenail concentrations; RAGE DNA methylation with iAs, and %DMA; and finally between TIMP1 DNA methylation with the first arsenic methylation. A negative correlation between MMP9 sputum levels with its DNA methylation was registered. In conclusion, arsenic levels were positive associated with the DNA methylation of extracellular matrix remodeling genes;, which in turn could modifies the biological process in which they are involved causing or predisposing to lung diseases.
Assuntos
Intoxicação por Arsênico/genética , Arsênio/efeitos adversos , Metilação de DNA/efeitos dos fármacos , Matriz Extracelular/metabolismo , Metaloproteinase 9 da Matriz/genética , Receptor para Produtos Finais de Glicação Avançada/genética , Inibidor Tecidual de Metaloproteinase-1/genética , Poluentes Químicos da Água/efeitos adversos , Fatores Etários , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/urina , Criança , Feminino , Marcadores Genéticos , Humanos , Masculino , Exposição Materna/efeitos adversos , Metaloproteinase 9 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/urina , Unhas/química , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Regiões Promotoras Genéticas , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Medição de Risco , Escarro/química , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Inibidor Tecidual de Metaloproteinase-1/urina , Abastecimento de ÁguaRESUMO
Inorganic arsenic (iAs) is an important pollutant associated with various chronic-degenerative diseases. The cytoprotective protein nuclear factor erythroid 2-related factor (NRF2) has been proposed as an important responsive mechanism against iAs exposure. The aim of this study was to determine whether the risk of skin lesions in people exposed to iAs-contaminated water could be modified by the presence of single nucleotide polymorphisms in the NRF2 coding gene. We studied 117 individuals with long-term iAs exposure and 120 nonexposed individuals. Total As was determined in water, meanwhile iAs and its metabolites were measured in urine. The iAs-induced skin lesion status was evaluated by expert dermatologists. We sequenced the promoter region of NRF2 in a sample of 120 healthy donors. We found four polymorphisms previously reported and one novel polymorphism in the 5' regulatory region of the NRF2. In this study, we did not find allelic and genotype association of NRF2 polymorphisms with iAs-related skin lesion. However, the analysis of haplotypes composed by -653GA, and -617CA NRF2 single nucleotide polymorphisms showed a significant association with protection against skin lesions in the low-As exposure group. This is the first report studying the association between NRF2 polymorphisms and susceptibility of As-related skin lesions. Increasing the sample size will allow us to confirm this data.
Assuntos
Intoxicação por Arsênico/genética , Arsênio/efeitos adversos , Fator 2 Relacionado a NF-E2/genética , Polimorfismo de Nucleotídeo Único , Dermatopatias/induzido quimicamente , Dermatopatias/genética , Poluentes Químicos da Água/efeitos adversos , Adolescente , Adulto , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/prevenção & controle , Estudos de Casos e Controles , Estudos Transversais , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Haplótipos , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Regiões Promotoras Genéticas , Fatores de Proteção , Fatores de Risco , Dermatopatias/diagnóstico , Dermatopatias/prevenção & controle , Adulto JovemRESUMO
Pre-Columbian populations that inhabited the Tarapacá mid river valley in the Atacama Desert in Chile during the Middle Horizon and Late Intermediate Period (AD 500-1450) show patterns of chronic poisoning due to exposure to geogenic arsenic. Exposure of these people to arsenic was assessed using synchrotron-based elemental X-ray fluorescence mapping, X-ray absorption spectroscopy, X-ray diffraction and Fourier transform infrared spectromicroscopy measurements on ancient human hair. These combined techniques of high sensitivity and specificity enabled the discrimination between endogenous and exogenous processes that has been an analytical challenge for archeological studies and criminal investigations in which hair is used as a proxy of premortem metabolism. The high concentration of arsenic mainly in the form of inorganic As(III) and As(V) detected in the hair suggests chronic arsenicism through ingestion of As-polluted water rather than external contamination by the deposition of heavy metals due to metallophilic soil microbes or diffusion of arsenic from the soil. A decrease in arsenic concentration from the proximal to the distal end of the hair shaft analyzed may indicate a change in the diet due to mobility, though chemical or microbiologically induced processes during burial cannot be entirely ruled out.
Assuntos
Intoxicação por Arsênico/diagnóstico , Arsênio/análise , Cabelo/química , História Medieval , Síncrotrons , Arsênio/metabolismo , Intoxicação por Arsênico/metabolismo , Chile , Humanos , Síncrotrons/estatística & dados numéricosRESUMO
BACKGROUND: Human exposures to inorganic arsenic (iAs) have been linked to an increased risk of diabetes mellitus. Recent laboratory studies showed that methylated trivalent metabolites of iAs may play key roles in the diabetogenic effects of iAs. Our study examined associations between chronic exposure to iAs in drinking water, metabolism of iAs, and prevalence of diabetes in arsenicosis-endemic areas of Mexico. METHODS: We used fasting blood glucose (FBG), fasting plasma insulin (FPI), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), and insulin resistance (HOMA-IR) to characterize diabetic individuals. Arsenic levels in drinking water and urine were determined to estimate exposure to iAs. Urinary concentrations of iAs and its trivalent and pentavalent methylated metabolites were measured to assess iAs metabolism. Associations between diabetes and iAs exposure or urinary metabolites of iAs were estimated by logistic regression with adjustment for age, sex, hypertension and obesity. RESULTS: The prevalence of diabetes was positively associated with iAs in drinking water (OR 1.13 per 10 ppb, p < 0.01) and with the concentration of dimethylarsinite (DMAsIII) in urine (OR 1.24 per inter-quartile range, p = 0.05). Notably, FPI and HOMA-IR were negatively associated with iAs exposure (ß -2.08 and -1.64, respectively, p < 0.01), suggesting that the mechanisms of iAs-induced diabetes differ from those underlying type-2 diabetes, which is typically characterized by insulin resistance. CONCLUSIONS: Our study confirms a previously reported, but frequently questioned, association between exposure to iAs and diabetes, and is the first to link the risk of diabetes to the production of one of the most toxic metabolites of iAs, DMAsIII.
Assuntos
Arsênio/urina , Ácido Cacodílico/análogos & derivados , Diabetes Mellitus/epidemiologia , Exposição Ambiental/análise , Adolescente , Adulto , Arsênio/análise , Arsênio/metabolismo , Arsênio/toxicidade , Intoxicação por Arsênico/complicações , Intoxicação por Arsênico/diagnóstico , Arsenicais/metabolismo , Arsenicais/urina , Glicemia/análise , Ácido Cacodílico/toxicidade , Ácido Cacodílico/urina , Estudos Transversais , Diabetes Mellitus/induzido quimicamente , Exposição Ambiental/efeitos adversos , Feminino , Teste de Tolerância a Glucose , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Humanos , Insulina/sangue , Resistência à Insulina , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Abastecimento de ÁguaRESUMO
Arsenic (As) is a semimetal that is widely distributed in nature, in water and soil. In Argentine, the contamination of both waterways and groundwater represents the main environmental problem caused by this element. Chronic As poisoning is known as Chronic endemic regional hydroarsenicism (C.E.R.HA.). Long-term exposure to low concentrations of the element from the prenatal period onward results in the well-known symptoms of chronic As poisoning. CERHA develops progressively, compromising different organs and systems, most importantly the skin. One of the most important complications of CERHA is de development of neoplasias, mainly skin tumors. Childhood environmental health is a challenge in the new millennium and health care professionals play a fundamental role in the protection against environmental hazards such as chronic arsenic poisoning.
Assuntos
Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/prevenção & controle , Poluentes Químicos da Água/intoxicação , Argentina , Intoxicação por Arsênico/epidemiologia , Intoxicação por Arsênico/terapia , Criança , Doença Crônica , HumanosRESUMO
El arsénico (As) es un semi-metal, ampliamente distribuido en la naturaleza en aguas y suelos. La contaminación de los cursos de agua, tanto superficiales como profundos, constituye el principal problema ambiental generado por este elemento. La intoxicación con As se denomina hidroarsenicismo crónico regional endémico (HACRE). Su importancia de la intoxicación crónica con As en la infancia está dada por los conocidos efectos asociados a la exposición acumulada desde el período prenatal en bajas concentraciones. El HACRE se desarrolla progresivamente, comprometiendo diversos órganos y sistemas, principalmente la piel. Una de las complicaciones más importantes del HACRE es el desarrollo de neoplasias, principalmente tumores cutáneos. El HACRE es una enfermedad prevenible. La salud ambiental infantil representa un desafío del nuevo milenio y los profesionales de la salud cumplen un rol fundamental frente a las amenazas ambientales como las que presentala intoxicación crónica con arsenico.
Arsenic (As) is a semimetal that is widely distributed in nature, in water and soil. In Argentine, the contamination of both waterways and groundwater represents the main environmental problem caused by this element. Chronic As poisoning is known as Chronic endemic regional hydroarsenicism (C.E.R.HA.). Long-term exposure to low concentrations of the element from the prenatal period onward results in the well-known symptoms of chronic As poisoning. CERHA develops progressively, compromising different organs and systems, most importantly the skin. One of the most important complications of CERHA is de development of neoplasias, mainly skin tumors. Childhood environmental health is a challenge in the new millennium and health care professionals play a fundamental role in the protection against environmental hazards such as chronic arsenic poisoning.
Assuntos
Humanos , Masculino , Criança , Doenças Endêmicas/prevenção & controle , Intoxicação por Arsênico/complicações , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/epidemiologia , Intoxicação por Arsênico/prevenção & controle , Intoxicação por Arsênico/terapiaRESUMO
El arsénico (As) es un semi-metal, ampliamente distribuido en la naturaleza en aguas y suelos. La contaminación de los cursos de agua, tanto superficiales como profundos, constituye el principal problema ambiental generado por este elemento. La intoxicación con As se denomina hidroarsenicismo crónico regional endémico (HACRE). Su importancia de la intoxicación crónica con As en la infancia está dada por los conocidos efectos asociados a la exposición acumulada desde el período prenatal en bajas concentraciones. El HACRE se desarrolla progresivamente, comprometiendo diversos órganos y sistemas, principalmente la piel. Una de las complicaciones más importantes del HACRE es el desarrollo de neoplasias, principalmente tumores cutáneos. El HACRE es una enfermedad prevenible. La salud ambiental infantil representa un desafío del nuevo milenio y los profesionales de la salud cumplen un rol fundamental frente a las amenazas ambientales como las que presentala intoxicación crónica con arsenico.(AU)
Arsenic (As) is a semimetal that is widely distributed in nature, in water and soil. In Argentine, the contamination of both waterways and groundwater represents the main environmental problem caused by this element. Chronic As poisoning is known as Chronic endemic regional hydroarsenicism (C.E.R.HA.). Long-term exposure to low concentrations of the element from the prenatal period onward results in the well-known symptoms of chronic As poisoning. CERHA develops progressively, compromising different organs and systems, most importantly the skin. One of the most important complications of CERHA is de development of neoplasias, mainly skin tumors. Childhood environmental health is a challenge in the new millennium and health care professionals play a fundamental role in the protection against environmental hazards such as chronic arsenic poisoning.(AU)
Assuntos
Humanos , Masculino , Criança , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/prevenção & controle , Intoxicação por Arsênico/complicações , Intoxicação por Arsênico/terapia , Intoxicação por Arsênico/epidemiologia , Doenças Endêmicas/prevenção & controleRESUMO
The aim of this study was to assess the value of the children's version of the Rey-Osterrieth Complex Figure Test as a screening test in a population exposed to different mixtures of neurotoxicants. Copy and Immediate Recall scores were evaluated through the test. Children were recruited from three sites; an area with natural contamination by fluoride and arsenic (F-As), a mining-metallurgical area with lead and arsenic contamination (Pb-As) and a malaria zone with the evidence of fish contaminated with dichlorodiphenyltrichloroethane (DDT) and polychlorinated biphenyls (PCBs). Children aged 6-11 years old, living in one of the three polluted sites since birth were recruited (n=166). The exposure was evaluated as follows: fluoride and arsenic in urine, lead in blood and DDT, dichlorodiphenyldichloroethylene (DDE) and PCBs in serum. To evaluate the test performance, z-scores for Copy and Immediate Recall were calculated. The proportion of children by residence area with performance lower than expected by age (below -1 SD) for Copy and Immediate Recall was in the F-As area (88.7% and 59%) and in the DDT-PCBs area (73% and 43.8%), respectively. In the Pb-As area, the proportion was 62% for both tests. After adjustment, Copy correlated inversely with fluoride in urine (r=-0.29; p<0.001) and Immediate Recall correlated inversely with fluoride in urine (r=-0.27; p<0.05), lead in blood (r=-0.72; p<0.01), arsenic in urine (r=-0.63; p<0.05) and DDE (r=-0.25; p<0.05). This study provided evidence that children included in this research are living in high risk areas and were exposed to neurotoxicants. Poor performance in the test could be explained in some way by F, Pb, As or DDE exposure, however social factors or the low quality of school education prevalent in the areas could be playing an important role.
Assuntos
Avaliação da Deficiência , Poluição Ambiental , Síndromes Neurotóxicas/diagnóstico , Índice de Gravidade de Doença , Amidas/urina , Antropometria/métodos , Arsênio/urina , Intoxicação por Arsênico/diagnóstico , Intoxicação por Arsênico/fisiopatologia , Criança , DDT/toxicidade , Monitoramento Ambiental , Monitoramento Epidemiológico , Feminino , Intoxicação por Flúor/diagnóstico , Intoxicação por Flúor/epidemiologia , Intoxicação por Flúor/fisiopatologia , Humanos , Hidrocarbonetos Fluorados/urina , Masculino , Síndromes Neurotóxicas/epidemiologia , Síndromes Neurotóxicas/etiologia , Neurotoxinas/classificação , Neurotoxinas/toxicidade , Bifenilos Policlorados/toxicidade , Reprodutibilidade dos TestesRESUMO
Utilizando el método de digestión ácida yEspectrofotometría de Absorción Atómica con Horno de Grafito, se determinó la concentración de As, en 390 muestras de orina y 384 muestras de cabellos de trabajadores de una empresa fundidora en Oruro. El promedio de As en orina fue 7,826 mg/L (DE=3,548mg/ L con 95% de confianza), mayor al Límite de Tolerancia Biológico (LTB) de 0,1mg/L sugerido por el Instituto Nacional para Salud y Seguridad en el Trabajo (NIOSH). El promedio de As en cabello fue 0,557mg/g (DE=3,741 con 95% de confianza), mucho mayor al LTB de0,001mg/g. El análisis de promedios de concentración en relación a la edad no determinó diferencias representativas. No se encontraron diferencias significativas tanto por la prueba t student (p>0.05)como por el método de Levenes (F=2.232; p=0.136), en las áreas de trabajo consideradas de exposición directa e indirecta.
Assuntos
Humanos , Arsenicais/análise , Arsênio/toxicidade , Intoxicação por Arsênico/diagnósticoRESUMO
Arsine intoxication is a true medical emergency with a high fatality rate, characteristic of acute and massive hemolysis. Inhalation of 250 ppm of arsine gas is instantly lethal. Exposure to 25 to 50 ppm for 30 minutes is lethal. Arsine is a colorless gas with a garlic scent, entering the organism by breathing and passing directly into the circulation. Its hemolytic activity is due to its ability to cause a fall in erythrocyte-reduced glutathione content. Manifestations are suggestive of a general toxic state with alterations of consciousness, from confusion until delirium, crash, hematuria, jaundice and renal insufficiency. This can generate confusion and difficulty in the diagnosis and in the opportune treatment to avoid death or sequelae. This type of intoxication must be suspected in electrolysis process workers or those working with lead, copper, zinc, iron, gold, silver and tin. In the present case, sources for arsenic ingestion in the organism were discarded and the presence of arsine in the workplace was confirmed. In spite of the administered treatment, the patient experienced renal insufficiency.